Buyer’s guide

How to choose an RCM partner

Eight questions that separate a partner who protects your revenue from one who simply processes it. Ask them of any vendor, including us.

QUESTION 01

How are you paid?

Percentage-of-collections pricing grows with your revenue, not with the work done, and it makes every dollar you recover cost you more.

A good answerA flat fee, agreed before you start.
QUESTION 02

Who approves what goes to the payer?

Your practice carries the risk on every claim. You should decide what is sent and what is written off.

A good answerYour team approves every claim and every write-off.
QUESTION 03

Do you catch problems before submission, or after a denial?

A denial costs time, cash flow and staff hours to rework. Prevention is cheaper than recovery.

A good answerProblems are caught before the claim is sent.
QUESTION 04

Will we understand every flag?

A code or a status your team can’t act on just moves the work around.

A good answerEvery flag comes with a plain-English reason and a next step.
QUESTION 05

Do we have to change our EHR or practice management system?

Switching systems disrupts scheduling, documentation and billing for months.

A good answerIt works beside the systems you already use.
QUESTION 06

What happens to underpayments?

Short payments are easy to miss and rarely chased. Over a year they add up.

A good answerEvery payment is reviewed, and short payments are followed up.
QUESTION 07

When is patient data protected, and how?

Data handling should be settled before any patient information moves.

A good answerA business associate agreement is signed before any data is shared, and every access is logged.
QUESTION 08

What are the contract terms?

Long terms and automatic renewals lock you in before you have seen results.

A good answerClear terms and no automatic renewal.
Side by side

Three ways to run your revenue cycle

Percentage-based billing serviceSoftware your staff runsClaira Health
PricingA percentage of collectionsSubscription, plus your staff’s timeA flat fee, agreed up front
Who does the workTheir staffYour staffAI agents, with your team approving
When problems are caughtVaries by serviceDepends on your staffBefore the claim is sent
Who makes the decisionsOften the serviceYour teamYour team, every time
What you can seeA monthly reportYour own reportsEvery flag, explained in plain English
Changing your systemsSometimes requiredUsually requiredNot required

General categories, not named vendors. Ask any vendor you’re considering to confirm their own terms.

Bring one recent denial. We'll show you the rule behind it.

Your specialty, your payers, your claim. No slides.

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